THE NEW YORKER, DECEMBER 9, 2013
55
By the turn of the century, there were
more U.S. prescriptions for Ambien
than for all benzodiazepines combined,
and Ambien's benign reputation seemed
to help normalize the idea of medical as-
sistance for insomnia. (In 1998, Kathy
Giusti, at the time a Searle executive, ex-
plained to an interviewer, "We had to
change consumer perception about the
sleep category in general, to eliminate
the stigma.") Between 1993 and 2006,
the number of times a year that a U.S.
doctor gave a diagnosis of insomnia rose
from fewer than a million to more than
five million.
In 1995, Kaplan negotiated a pay-
ment---about thirty thousand dollars---
from his former employers. George, who
stayed at the company, happily, until his
retirement, in 2010, received a little less.
After Kaplan retired from his career in
law, he formed an organization that lob-
bies on behalf of people who invent things
while working as a salaried employee.
Kaplan described zolpidem as a "pro-
fessional disaster." He added, "It's not life-
saving, it does not treat cancer, it does
not treat malaria, it does not treat Alzhei-
mer's---the most difficult illnesses to treat.
Therefore, I call it a comfort drug."
A woman recently posted online a de-
scription of her Ambien experiences:
Ordered 3 pairs of saddle shoes from eBay
Sexted my best male friend who is mar-
ried. I have a BF as well
Ordered $35.00 stylus off of amazon, I
must have thought it said $3.00 or some-
thing
Played draw something w/my friend and
drew penises and rainbows for every word
Tried to legally change my name on the
computer
Ambien can be disinhibiting and deper-
sonalizing. Or, to quote from the label of
a bottle of sleep medication used by Tina
Fey's character, Liz Lemon, on "30 Rock":
"May cause dizziness, sexual nightmares,
and sleep crime." Zolpidem enters the
gut, passes into the bloodstream, squeezes
through the liver, and then crosses the
blood-brain barrier, to make GABA recep-
tors more receptive to GABA. When the
neurotransmitter sticks to its target, neg-
atively charged chloride ions flow into
cells, making the inside of the cells more
negative, and less likely to fire. Traffic is
interrupted, signals don't reach their des-
tinations, and the brain starts to quiet.
Many people experience this as a con-
tented swoon that silences inner chatter
while giving a half glimpse of childhood;
they are overtaken by sleep, like a three-
year-old in a car seat.
But others resist sleep and embrace
the woozy, out-of-body license. To some,
this is an opportunity to take part in
what Rachel Uchitel, a former girlfriend
of Tiger Woods, has reportedly described
as "crazy Ambien sex." At the London
Olympics, some Australian swimmers
took Ambien to build team spirit. After
taking the drug, they larked around and
knocked on the doors of other athletes.
As one of them later put it, they allowed
themselves "to be normal for one night."
Because the drug had been banned by the
Australian Olympic Committee, and be-
cause the team failed to win medals that
it was expected to win, this became a na-
tional scandal.
But for many Ambien users, like the
eBay shopper, their activities on the bor-
der of wakefulness and sleep are less pur-
poseful. Drew Fairweather, an online car-
toonist, has described the phenomenon in
a popular series of panels in which a wal-
rus addresses a human companion with
such suggestions as "Take some more
Ambien and cut off all your hair, man.
Let's do this." In 2006, Patrick Kennedy,
then a congressman, crashed his Mustang
into a barrier near Capitol Hill, in the
middle of the night; he told police, inac-
curately, that he was late for a vote. He
had Ambien and an anti-nausea medica-
tion in his body. By the following spring,
the F.D.A. had heard enough about
Ambien-related sleep-driving, sleep-eat-
ing, and sleep-walking---accompanied by
amnesia---to require new warnings. The
drug's label now refers to the risk of "pre-
paring and eating food, making phone
calls, or having sex."
This kind of behavior can occur dur-
ing dreamless, slow-wave sleep---the state
of an unmedicated sleepwalker---or, more
commonly, Jed Black suspects, while
someone is awake but disinhibited, by
Ambien alone or by Ambien and alcohol.
Black noted that this altered state can be
mischaracterized as sleep by people who
have forgotten their adventures. A recent
study, described in European Neuropsycho-
pharmacology, suggests that these phe-
nomena affect five per cent of users. (Other
studies have reported lower numbers.)
Zolpidem's reputation for outlandish side
effects may be inflated by gossip---by the
interaction of medication and the Inter-
net. Thomas Roth, the director of the
sleep center at Henry Ford Hospital, in
Detroit, who has consulted for Merck and
other pharmaceutical companies, told me
he has not yet seen persuasive evidence
that there is more of this behavior among
Ambien users than among the rest of the
population (which includes drinkers).
The F.D.A.'s 2007 warnings were
prompted by doctors' reports, not by peer-
reviewed data. But amnesiac confusion
certainly occurs, and zolpidem's popular-
ity makes misadventures commonplace,
to the point that it's hard to use Ambien
in a criminal defense. Defendants must
argue that they were involuntarily intoxi-
cated---that they couldn't have foreseen
the possible consequences of taking Am-
bien, alone or with drinks---despite the
warnings delivered both by their doctor
and by Charlie Sheen, who called the
drug "the devil's aspirin" after an incident,
in 2010, involving a porn star and a dam-
aged chandelier, in the Eloise Suite of the
Plaza Hotel.
There may be other risks associated
with zolpidem. In a recent paper in
the online edition of the British Medi-
cal Journal, Daniel Kripke, a professor
emeritus at the University of California
San Diego School of Medicine, exam-
ined five years of electronic medical
records collected by a health system in
Pennsylvania. He compared more than
ten thousand patients who had been
prescribed a sleep medicine---most
commonly Ambien---and more than
twenty thousand patients who had not.
After adjusting for age, gender, smoking
habits, obesity, ethnicity, alcohol use,
and a history of cancer, and after con-
trolling, as much as possible, for other
diseases and disorders, Kripke found
that people who had taken sleeping pills
were more than three times as likely to
have died during the study period as
those who had not. Those on higher